基于PCMH内涵的家庭医生签约服务质量优化体系构建与社区实证研究

以患者为中心的医疗之家（PCMH）是优质基本医疗服务的良好框架性模式，其内涵及标准化认证项目，对我国社区家庭医生签约服务质量提升具有借鉴意义。前期对附属社区卫生服务中心的调研结果发现，目前家庭医生服务已经具备了PCMH的一些基本特质，但因存在短板而影响整体质量。因此提高家庭医生签约服务质量的关键是构建标准化评估系统，根据评估结果针对性设计质量提升措施，并按照科学的质量提升路径实施。本研究将从PCMH的核心内涵出发，结合我国社区卫生服务中心发展的现状和趋势，通过研究PCMH认证标准及国内外优秀服务模式转型的实践经验，以服务质量评估标准化及提升路径科学化为手段，构建具有中国特色的家庭医生签约服务质量优化体系。并通过其在社区的实证研究，验证该体系的实操性及有效性，以此探索其未来推广至全上海乃至全国的可能性，为推动我国现阶段医改工作重心之一的基层社区医疗卫生服务水平的提升提供新的突破口。

Patient-Centered Medical Home (PCMH) is a well-organized framework model for high-quality primary care services. Its core attributes and standardized certification programs can be used as references for quality improvement of family doctors’ contracted services in China’s community health service centers (CHSCs). The previous research results of the field investigations on affiliated CHSCs found that the current services have equipped with some fundamental PCMH attributes, but the overall quality was hindered by existing shortcomings. Therefore, the key to improving the quality of family doctors' contracted services is to construct a standardized quality evaluation system, and implement quality improvement measures according to the assessment results and following scientific pathway. This study plan to start by investigating the core attributes of PCMH, and the development status and trend of China's CHSCs. Using PCMH certification standards and the practical experience of domestic and foreign excellent examples of service model transformation as references, the study aims at establishing a health service quality improvement system with Chinese health services’ characteristics embedded by constructing a standardized quality evaluation program and a scientific quality improvement pathway. This system will be tested in our affiliated CHSCs through empirical research, which aims at verifying the system’s operability and effectiveness, in order to explore the possibility of its future promotion to other CHSCs in Shanghai and even in the whole country. This study will provide a new breakthrough for promoting the quality of community health services, which is one of the priorities in the current health care reform.